REVITALIZE PHYSICAL THERAPY PLLC
NPI 1114894417
Clinic/Center - Physical Therapy in Vancouver, WA
About Revitalize Physical Therapy Pllc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
REVITALIZE PHYSICAL THERAPY PLLC (NPI 1114894417) is a healthcare organization registered as a physical therapy in Vancouver, Washington and active in the NPI registry since October 2025. The organization lists Ryan Iggulden, Owner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Revitalize Physical Therapy Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Revitalize Physical Therapy PLLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Revitalize Physical Therapy PLLC's NPI number?
The NPI number for Revitalize Physical Therapy PLLC is 1114894417. It was assigned to this organization in the NPPES registry on October 21, 2025.
Where is Revitalize Physical Therapy PLLC located?
Revitalize Physical Therapy PLLC is located at 2102 E Mcloughlin Blvd, Vancouver, WA 98661. The listed phone number is (360) 448-3544.
What is Revitalize Physical Therapy PLLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Physical Therapy, with taxonomy code 261QP2000X.
Is Revitalize Physical Therapy PLLC enrolled in Medicare?
Yes. Revitalize Physical Therapy PLLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Revitalize Physical Therapy PLLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Physical Therapist in Private Practice) reassigns their Medicare billing to Revitalize Physical Therapy PLLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
What insurance does Revitalize Physical Therapy PLLC accept?
Health plans from BridgeSpan Health Company, Moda Health Plan, Inc., Providence Health Plan and Regence BlueCross BlueShield of Oregon list Revitalize Physical Therapy PLLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.
When was this NPI record last updated?
The NPPES record for Revitalize Physical Therapy PLLC was last updated on October 21, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Revitalize Physical Therapy Pllc · NPI 1114894417
Physical Therapy organization in Vancouver, Washington. Organization record, active in the CMS NPPES registry since October 21, 2025.
## Identity
- **NPI:** 1114894417 (Entity type: Organization)
- **Enumerated:** October 21, 2025
- **Primary specialty:** Clinic/Center - Physical Therapy · taxonomy 261QP2000X
- **Organization subpart:** No
- **Authorized official:** Ryan Iggulden, OWNER
## Practice location
- **Address:** 2102 E MCLOUGHLIN BLVD, Vancouver, WA 98661-4130
- **Phone:** (360) 448-3544
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Physical Therapist in Private Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** October 21, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1114894417) · Data from the CMS NPPES public registry.